Dormann Harald, Criegee-Rieck Manfred, Neubert Antje, Egger Tobias, Geise Arnim, Krebs Sabine, Schneider Thomas, Levy Micha, Hahn Eckhart, Brune Kay
Department of Internal Medicine I, University of Erlangen-Nuremberg, Erlangen, Germany.
Drug Saf. 2003;26(5):353-62. doi: 10.2165/00002018-200326050-00004.
Adverse drug reactions (ADRs) are a well-known cause of hospital admission. Nevertheless a quantitative estimate of the preventability of and physicians' awareness of these reactions is lacking.
Using intensive bedside and computer-assisted drug surveillance methods a 13-month prospective pharmacoepidemiological survey was carried out on patients admitted to two medical wards of the Erlangen-Nuremberg University Hospital in Erlangen, Germany. This study aimed to define the incidence of preventable and unavoidable ADRs. In addition we investigated the awareness of the physicians to ADRs at the time of admission and the rate of contraindicated pre-admission prescriptions.
In 78 (8.5%) of 915 (10.9%) admissions a total of 102 (42 preventable) community-acquired ADRs were detected on admission. In 45 (3.8%) of the admissions ADRs led directly to hospitalisation. 56.9% of the ADRs were not recognised by the attending physician on admission. Marked correlation was found between the awareness of ADRs and their probability and severity scores (r = 0.85 and r = 0.94, respectively; p < 0.05). The most frequently detected ADRs were due to direct toxicity and secondary pharmacological effects. Idiosyncratic reactions were often missed and 18.6% of all drugs prescribed prior to admission were contraindicated. Leading the list were diuretics, analgesics/NSAIDs and antipsychotics/sedatives.
Awareness of existing ADRs on hospital admission and appropriate prescribing prior to hospital admission require attention. Early detection of ADRs on hospital admission can be achieved by the use of computer support systems. Many ADRs could be prevented by adhering to indications and contraindications.
药物不良反应（ADR）是导致住院的一个众所周知的原因。然而，目前缺乏对这些反应可预防性及医生对此认识的定量评估。
采用强化床边及计算机辅助药物监测方法，对德国埃尔朗根-纽伦堡大学医院埃尔朗根分院两个内科病房收治的患者进行了为期13个月的前瞻性药物流行病学调查。本研究旨在确定可预防和不可避免的ADR的发生率。此外，我们还调查了医生在患者入院时对ADR的认识以及入院前禁忌处方的比例。
在915例（10.9%）入院患者中的78例（8.5%）中，入院时共检测到102例社区获得性ADR（其中42例可预防）。在45例（3.8%）入院患者中，ADR直接导致了住院。56.9%的ADR在入院时未被主治医生识别。ADR的认识与其可能性和严重程度评分之间存在显著相关性（分别为r = 0.85和r = 0.94；p < 0.05）。最常检测到的ADR是由于直接毒性和继发药理作用。特异反应常被漏诊，入院前开具的所有药物中有18.6%是禁忌的。排在首位的是利尿剂、镇痛药/非甾体抗炎药和抗精神病药/镇静剂。
需要关注入院时对现有ADR的认识以及入院前的合理处方。通过使用计算机支持系统可以在入院时早期发现ADR。遵守适应证和禁忌证可预防许多ADR。
